Document dQNVrn0Lnj4J5gDbnXBXbB810

Ba l t im o r e C it y H o sp it a l s F r e p e r i c G. H u b b a r d d ir e c t o r 4 9 4 0 EASTERN AV EN U E BALTI M ORE, M ARYLAN D 2 1 2 2 4 February 2, 1966 IN REP LY REFER TO: Dr. Robert A. Kehoe Kettering Laboratory College of Medicine University of Cincinnati Eden Avenue Cincinnat i, Ohio 45219 Dear Dr. Kehoe: Thank you so much for youri letter of January 24. I do believe that we are sub st ant ially in agreement on the question of "mobilization of lead". I am enclosing a reprint of an art icle I recently prepared. This expresses my thoughts on some ideas that we have discussed recent Iyj. In particular, I should be most anxious to have your comments on the portion o^ the reprint on page 5 that I have marked in ink beginning with the sentence "Tfjiis is because BAL but not EDTA removes significant amounts of lead from the red c e l l s................. ". I might add that I am trying this idea out at present and it does, indeed, appear to be possible to maintain blood lead concentrations within the normal range immediately following their recovery from acute lead encephalopathy. At present, we are treating the acute episode with BAL- EDTA and immediately following it with the institution of long-term oral penicillamine therapy at a dosage of 250 to 500 mg d aily. At the moment, I am interested to see whether we are going to encounter significant drug t oxicity. So far this has not been a problem. Indeed, it seems in some patients we were able to maintain blood lead concentration at a subnormal level. I am wondering whether this might accelerate the mobilization excretion of excess body lead in comparison with the rate at whidh this process occurs normally. If it does not appear that we w ill encounter sdrious drug t o xicit y we plan to commence a study of this problem in a more formal fashion in the summer of 1966. I should be most appreciative of any comments yo'u care to make on this point. ' . 1/Sincerely yours, v - , r/ 7 _ ,, J. / Julian Chisolm . Jr ., M. t>. Associate Professor of Pediatrics Johns Hopkins University School of M edicine